United States General Accounting Office
GAO
Testimony
Before the Subcommittee on Oversight and
Investigations, Committee on Energy and Commerce,
House of Representatives
For Release on Delivery
Expected at 9:00 a.m.
Tuesday, June 25, 2002
HOMELAND SECURITY
New Department Could
Improve Coordination but
May Complicate Public
Health Priority Setting
Statement of Janet Heinrich
Director, Health Care—Public Health Issues
GAO-02-883T
Mr. Chairman and Members of the Committee:
I appreciate the opportunity to be here today to discuss the proposed
creation of the Department of Homeland Security. Since the terrorist
attacks of September 11, 2001, and the subsequent anthrax incidents, there
has been concern about the ability of the federal government to prepare
for and coordinate an effective public health response to such events,
given the broad distribution of responsibility for that task at the federal
level. Our earlier work found, for example, that more than 20 federal
departments and agencies carry some responsibility for bioterrorism
preparedness and response and that these efforts are fragmented.1
Emergency response is further complicated by the need to coordinate
actions with agencies at the state and local level, where much of the
response activity would occur.
The President’s proposed Homeland Security Act of 2002 would bring
many of these federal entities with homeland security responsibilities—
including public health preparedness and response—into one department,
in an effort to mobilize and focus assets and resources at all levels of
government. The aspects of the proposal concerned with public health
preparedness and response would involve two primary changes to the
current system, which are found in Title V of the proposed bill. First, the
proposal would transfer certain emergency preparedness and response
programs from multiple agencies to the new department. Second, it would
transfer the control over, but not the operation of, other public health
preparedness assistance programs, such as providing emergency
preparedness planning assistance to state and local governments, from the
Department of Health and Human Services (HHS) to the new department.2
In order to assist the committee in its consideration of this extensive
reorganization of our government, my remarks today will focus on Title V
of the President’s proposal and the implications of (1) the proposed
transfer of specific public health preparedness and response programs
currently housed in HHS into the new department and (2) the proposed
transfer of control over certain other public health preparedness
assistance programs from HHS to the new department. My testimony
1
U.S. General Accounting Office, Bioterrorism: Federal Research and Preparedness
Activities, GAO-01-915, (Washington, D.C.: Sept. 28, 2001).
2
These changes are primarily covered by Sections 502 and 505, respectively, in Title V of
the President’s proposed legislation.
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today is based largely on our previous and ongoing work on federal, state,
and local preparedness in responding to bioterrorist threats,3 as well as a
review of the proposed legislation.
In summary, we believe that the proposed reorganization has the potential
to repair the fragmentation we have noted in the coordination of public
health preparedness and response programs at the federal, state, and local
levels. As we have recommended, the proposal would institutionalize the
responsibility for homeland security in federal statute. We expect that, in
addition to improving overall coordination, the transfer of programs from
multiple agencies to the new department could reduce overlap among
programs and facilitate response in times of disaster. However, we have
concerns about the proposed transfer of control from HHS to the new
department for public health assistance programs that have both basic
public health and homeland security functions. These dual-purpose
programs have important synergies that we believe should be maintained.
We are concerned that transferring control over these programs, including
priority setting, to the new department has the potential to disrupt some
programs that are critical to basic public health responsibilities. We do not
believe that the President’s proposal is sufficiently clear on how both the
homeland security and the public health objectives would be
accomplished.
Background
Federal, state, and local government agencies have differing roles with
regard to public health emergency preparedness and response. The federal
government conducts a variety of activities, including developing
interagency response plans, increasing state and local response
capabilities, developing and deploying federal response teams, increasing
the availability of medical treatments, participating in and sponsoring
exercises, planning for victim aid, and providing support in times of
disaster and during special events such as the Olympic games. One of its
main functions is to provide support for the primary responders at the
state and local level, including emergency medical service personnel,
public health officials, doctors, and nurses. This support is critical because
the burden of response falls initially on state and local emergency
response agencies.
3
See “Related GAO Products” at the end of this testimony.
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The President’s proposal transfers control over many of the programs that
provide preparedness and response support for the state and local
governments to a new Department of Homeland Security. Among other
changes, the proposed bill transfers HHS’s Office of the Assistant
Secretary for Public Health Emergency Preparedness to the new
department. Included in this transfer is the Office of Emergency
Preparedness (OEP), which currently leads the National Disaster Medical
System (NDMS)4 in conjunction with several other agencies and the
Metropolitan Medical Response System (MMRS).5 The Strategic National
Stockpile,6 currently administered by the Centers for Disease Control and
Prevention (CDC), would also be transferred, although the Secretary of
Health and Human Services would still manage the stockpile and continue
to determine its contents.
Under the President’s proposal, the new department would also be
responsible for all current HHS public health emergency preparedness
activities carried out to assist state and local governments or private
organizations to plan, prepare for, prevent, identify, and respond to
biological, chemical, radiological, and nuclear events and public health
emergencies. Although not specifically named in the proposal, this would
include CDC’s Bioterrorism Preparedness and Response program and the
Health Resources and Services Administration’s (HRSA) Bioterrorism
Hospital Preparedness Program. These programs provide grants to states
and cities to develop plans and build capacity for communication, disease
surveillance, epidemiology, hospital planning, laboratory analysis, and
other basic public health functions. Except as directed by the President,
the Secretary of Homeland Security would carry out these activities
through HHS under agreements to be negotiated with the Secretary of
4
In the event of an emergency, the National Disaster Medical System has response teams
that can provide support at the site of a disaster. These include specialized teams for burn
victims, mental health teams, teams for incidents involving weapons of mass destruction,
and mortuary teams that can be deployed as needed. About 2,000 civilian hospitals have
pledged resources that could be marshaled in any domestic emergency under the system.
5
The Metropolitan Medical Response System is a program that provides support for local
community planning and response capabilities for mass casualty and terrorist incidents in
metropolitan areas.
6
The stockpile, previously called the National Pharmaceutical Stockpile, consists of two
major components. The first component is the 12-Hour Push Packages, which contain
pharmaceuticals, antidotes, and medical supplies and can be delivered to any site in the
United States within 12 hours of a federal decision to deploy assets. The second component
is the Vendor Managed Inventory.
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HHS. Further, the Secretary of Homeland Security would be authorized to
set the priorities for these preparedness and response activities.
Reorganization Has
Potential to Improve
Coordination
The consolidation of federal assets and resources in the President’s
proposed legislation has the potential to improve coordination of public
health preparedness and response activities at the federal, state, and local
levels. Our past work has detailed a lack of coordination in the programs
that house these activities, which are currently dispersed across numerous
federal agencies. In addition, we have discussed the need for an
institutionalized responsibility for homeland security in federal statute.7
The proposal provides the potential to consolidate programs, thereby
reducing the number of points of contact with which state and local
officials have to contend, but coordination would still be required with
multiple agencies across departments. Many of the agencies involved in
these programs have differing perspectives and priorities, and the
proposal does not sufficiently clarify the lines of authority of different
parties in the event of an emergency, such as between the Federal Bureau
of Investigation (FBI) and public health officials investigating a suspected
bioterrorist incident. Let me provide you more details.
We have reported that many state and local officials have expressed
concerns about the coordination of federal public health preparedness and
response efforts.8 Officials from state public health agencies and state
emergency management agencies have told us that federal programs for
improving state and local preparedness are not carefully coordinated or
well organized. For example, federal programs managed by the Federal
Emergency Management Agency (FEMA), Department of Justice (DOJ),
and OEP and CDC all currently provide funds to assist state and local
governments. Each program conditions the receipt of funds on the
completion of a plan, but officials have told us that the preparation of
multiple, generally overlapping plans can be an inefficient process.9 In
addition, state and local officials told us that having so many federal
entities involved in preparedness and response has led to confusion,
7
U.S. General Accounting Office, Homeland Security: Responsibility and Accountability
for Achieving National Goals, GAO-02-627T (Washington, D.C.: Apr. 11, 2002).
8
U.S. General Accounting Office, Bioterrorism: Federal Research and Preparedness
Activities, GAO-01-915, (Washington, D.C.: Sept. 28, 2001).
9
U.S. General Accounting Office, Combating Terrorism: Intergovernmental Partnership
in a National Strategy to Enhance State and Local Preparedness, GAO-02-547T
(Washington, D.C.: Mar. 22, 2002).
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making it difficult for them to identify available federal preparedness
resources and effectively partner with the federal government.
The proposed transfer of numerous federal response teams and assets to
the new department would enhance efficiency and accountability for these
activities. This would involve a number of separate federal programs for
emergency preparedness and response, including FEMA; certain units of
DOJ; and HHS’s Office of the Assistant Secretary for Public Health
Emergency Preparedness, including OEP and its NDMS and MMRS
programs, along with the Strategic National Stockpile. In our previous
work, we found that in spite of numerous efforts to improve coordination
of the separate federal programs, problems remained, and we
recommended consolidating the FEMA and DOJ programs to improve the
coordination.10 The proposal places these programs under the control of
one person, the Under Secretary for Emergency Preparedness and
Response, who could potentially reduce overlap and improve
coordination. This change would make one individual accountable for
these programs and would provide a central source for federal assistance.
The proposed transfer of MMRS, a collection of local response systems
funded by HHS in metropolitan areas, has the potential to enhance its
communication and coordination. Officials from one state told us that
their state has MMRSs in multiple cities but there is no mechanism in
place to allow communication and coordination among them. Although
the proposed department has the potential to facilitate the coordination of
this program, this example highlights the need for greater regional
coordination, an issue on which the proposal is silent.
Because the new department would not include all agencies having public
health responsibilities related to homeland security, coordination across
departments would still be required for some programs. For example,
NDMS functions as a partnership among HHS, the Department of Defense
(DOD), the Department of Veterans Affairs (VA), FEMA, state and local
governments, and the private sector. However, as the DOD and VA
programs are not included in the proposal, only some of these federal
organizations would be brought under the umbrella of the Department of
Homeland Security. Similarly, the Strategic National Stockpile currently
involves multiple agencies. It is administered by CDC, which contracts
10
U.S. General Accounting Office, Combating Terrorism: Selected Challenges and Related
Recommendations, GAO-01-822 (Washington, D.C., Sept. 20, 2001).
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with VA to purchase and store pharmaceutical and medical supplies that
could be used in the event of a terrorist incident. Recently expanded and
reorganized, the program will now include management of the nation’s
inventory of smallpox vaccine. Under the President’s proposal, CDC’s
responsibilities for the stockpile would be transferred to the new
department, but VA and HHS involvement would be retained, including
continuing review by experts of the contents of the stockpile to ensure
that emerging threats, advanced technologies, and new countermeasures
are adequately considered.
Although the proposed department has the potential to improve
emergency response functions, its success is contingent on several factors.
In addition to facilitating coordination and maintaining key relationships
with other departments, these include merging the perspectives of the
various programs that would be integrated under the proposal, and
clarifying the lines of authority of different parties in the event of an
emergency. As an example, in the recent anthrax events, local officials
complained about differing priorities between the FBI and the public
health officials in handling suspicious specimens. According to the public
health officials, FBI officials insisted on first informing FBI managers of
any test results, which delayed getting test results to treating physicians.
The public health officials viewed contacting physicians as the first
priority in order to ensure that effective treatment could begin as quickly
as possible.
New Department’s
Control of Essential
Public Health
Capacities Raises
Concern
The President’s proposal to shift the responsibility for all programs
assisting state and local agencies in public health emergency preparedness
and response from HHS to the new department raises concern because of
the dual-purpose nature of these activities. These programs include
essential public health functions that, while important for homeland
security, are critical to basic public health core capacities.11 Therefore, we
are concerned about the transfer of control over the programs, including
priority setting, that the proposal would give to the new department. We
recognize the need for coordination of these activities with other
11
The recently enacted Public Health Security and Bioterrorism Preparedness and
Response Act of 2002 (P.L.107-188) cited core public health capacities that state and local
governments need, including effective public health surveillance and reporting
mechanisms, appropriate laboratory capacity, properly trained and equipped public health
and medical personnel, and communications networks that can effectively disseminate
relevant information in a timely and secure manner.
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homeland security functions, but the President’s proposal is not clear on
how the public health and homeland security objectives would be
balanced.
Under the President’s proposal, responsibility for programs with dual
homeland security and public health purposes would be transferred to the
new department. These include such current HHS assistance programs as
CDC’s Bioterrorism Preparedness and Response program and HRSA’s
Bioterrorism Hospital Preparedness Program. Functions funded through
these programs are central to investigations of naturally occurring
infectious disease outbreaks and to regular public health communications,
as well as to identifying and responding to a bioterrorist event. For
example, CDC has used funds from these programs to help state and local
health agencies build an electronic infrastructure for public health
communications to improve the collection and transmission of
information related to both bioterrorist incidents and other public health
events.12 Just as with the West Nile virus outbreak in New York City, which
initially was feared to be the result of bioterrorism,13 when an unusual case
of disease occurs public health officials must investigate to determine
whether it is naturally occurring or intentionally caused. Although the
origin of the disease may not be clear at the outset, the same public health
resources are needed to investigate, regardless of the source.
States are planning to use funds from these assistance programs to build
the dual-purpose public health infrastructure and core capacities that the
recently enacted Public Health Security and Bioterrorism Preparedness
and Response Act of 200214 stated are needed. States plan to expand
laboratory capacity, enhance their ability to conduct infectious disease
surveillance and epidemiological investigations, improve communication
among public health agencies, and develop plans for communicating with
the public. States also plan to use these funds to hire and train additional
staff in many of these areas, including epidemiology.
12
These include the Health Alert Network (HAN), a nationwide system that facilitates the
distribution of health alerts, dissemination of prevention guidelines and other information,
distance learning, national disease surveillance, and electronic laboratory reporting, and
Epi-X, a secure Web-based disease surveillance network for federal, state, and local
epidemiologists that provides tools for searching, tracking, discussing, and reporting on
diseases and is therefore a key element in any disease investigation.
13
U.S. General Accounting Office, West Nile Virus Outbreak: Lessons for Public Health
Preparedness, GAO/HEHS-00-180 (Washington, D.C.: Sept. 11, 2000).
14
P.L. 107-188.
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Our concern regarding these dual-purpose programs relates to the
structure provided for in the President’s proposal. The Secretary of
Homeland Security would be given control over programs to be carried
out by another department. The proposal also authorizes the President to
direct that these programs no longer be carried out in this manner, without
addressing the circumstances under which such authority would be
exercised. We are concerned that this approach may disrupt the synergy
that exists in these dual-purpose programs. We are also concerned that the
separation of control over the programs from their operations could lead
to difficulty in balancing priorities. Although the HHS programs are
important for homeland security, they are just as important to the day-today needs of public health agencies and hospitals, such as reporting on
disease outbreaks and providing alerts to the medical community. The
current proposal does not clearly provide a structure that ensures that
both the goals of homeland security and public health will be met.
Concluding
Observations
Many aspects of the proposed consolidation of response activities are in
line with our previous recommendations to consolidate programs,
coordinate functions, and provide a statutory basis for leadership of
homeland security. The transfer of the HHS medical response programs
has the potential to reduce overlap among programs and facilitate
response in times of disaster. However, we are concerned that the
proposal does not provide the clear delineation of roles and
responsibilities that we have stated is needed. We are also concerned
about the broad control the proposal grants to the new department for
public health preparedness programs. Although there is a need to
coordinate these activities with the other homeland security preparedness
and response programs that would be brought into the new department,
there is also a need to maintain the priorities for basic public health
capacities that are currently funded through these dual-purpose programs.
We do not believe that the President’s proposal adequately addresses how
to accomplish both objectives.
Mr. Chairman, this completes my prepared statement. I would be happy to
respond to any questions you or other Members of the Committee may
have at this time.
Contact and
Acknowledgments
For further information about this testimony, please contact me at (202)
512-7118. Marcia Crosse, Greg Ferrante, Deborah Miller, and Roseanne
Price also made key contributions to this statement.
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Related GAO Products
Homeland Security
Homeland Security: Key Elements to Unify Efforts Are Underway but
Uncertainty Remains. GAO-02-610. Washington, D.C.: June 7, 2002.
Homeland Security: Responsibility and Accountability for Achieving
National Goals. GAO-02-627T. Washington, D.C.: April 11, 2002.
Homeland Security: Progress Made; More Direction and Partnership
Sought. GAO-02-490T. Washington, D.C.: March 12, 2002.
Homeland Security: Challenges and Strategies in Addressing Short- and
Long-Term National Needs. GAO-02-160T. Washington, D.C.: November 7,
2001.
Homeland Security: A Risk Management Approach Can Guide
Preparedness Efforts. GAO-02-208T. Washington, D.C.: October 31, 2001.
Homeland Security: Need to Consider VA’s Role in Strengthening Federal
Preparedness. GAO-02-145T. Washington, D.C.: October 15, 2001.
Homeland Security: Key Elements of a Risk Management Approach.
GAO-02-150T. Washington, D.C.: October 12, 2001.
Homeland Security: A Framework for Addressing the Nation’s Efforts.
GAO-01-1158T. Washington, D.C.: September 21, 2001.
Public Health
Bioterrorism: The Centers for Disease Control and Prevention’s Role in
Public Health Protection. GAO-02-235T. Washington, D.C.: November 15,
2001.
Bioterrorism: Review of Public Health Preparedness Programs. GAO-02149T. Washington, D.C.: October 10, 2001.
Bioterrorism: Public Health and Medical Preparedness. GAO-02-141T.
Washington, D.C.: October 9, 2001.
Bioterrorism: Coordination and Preparedness. GAO-02-129T.
Washington, D.C.: October 5, 2001.
Bioterrorism: Federal Research and Preparedness Activities. GAO-01915. Washington, D.C.: September 28, 2001.
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Chemical and Biological Defense: Improved Risk Assessment and
Inventory Management Are Needed. GAO-01-667. Washington, D.C.:
September 28, 2001.
Combating Terrorism: Need for Comprehensive Threat and Risk
Assessments of Chemical and Biological Attacks. GAO/NSIAD-99-163.
Washington, D.C.: September 14, 1999.
West Nile Virus Outbreak: Lessons for Public Health Preparedness.
GAO/HEHS-00-180. Washington, D.C.: September 11, 2000.
Chemical and Biological Defense: Program Planning and Evaluation
Should Follow Results Act Framework. GAO/NSIAD-99-159. Washington,
D.C.: August 16, 1999.
Combating Terrorism: Observations on Biological Terrorism and Public
Health Initiatives. GAO/T-NSIAD-99-112. Washington, D.C.: March 16,
1999.
Combating Terrorism
National Preparedness: Technologies to Secure Federal Buildings. GAO02-687T. Washington, D.C.: April 25, 2002.
National Preparedness: Integration of Federal, State, Local, and Private
Sector Efforts Is Critical to an Effective National Strategy for Homeland
Security. GAO-02-621T. Washington, D.C.: April 11, 2002.
Combating Terrorism: Intergovernmental Cooperation in the
Development of a National Strategy to Enhance State and Local
Preparedness. GAO-02-550T. Washington, D.C.: April 2, 2002.
Combating Terrorism: Enhancing Partnerships Through a National
Preparedness Strategy. GAO-02-549T. Washington, D.C.: March 28, 2002.
Combating Terrorism: Critical Components of a National Strategy to
Enhance State and Local Preparedness. GAO-02-548T. Washington, D.C.:
March 25, 2002.
Combating Terrorism: Intergovernmental Partnership in a National
Strategy to Enhance State and Local Preparedness. GAO-02-547T.
Washington, D.C.: March 22, 2002.
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Combating Terrorism: Key Aspects of a National Strategy to Enhance
State and Local Preparedness. GAO-02-473T. Washington, D.C.: March 1,
2002.
Chemical and Biological Defense: DOD Should Clarify Expectations for
Medical Readiness. GAO-02-219T. Washington, D.C.: November 7, 2001.
Anthrax Vaccine: Changes to the Manufacturing Process. GAO-02-181T.
Washington, D.C.: October 23, 2001.
Chemical and Biological Defense: DOD Needs to Clarify Expectations for
Medical Readiness. GAO-02-38. Washington, D.C.: October 19, 2001.
Combating Terrorism: Considerations for Investing Resources in
Chemical and Biological Preparedness. GAO-02-162T. Washington, D.C.:
October 17, 2001.
Combating Terrorism: Selected Challenges and Related
Recommendations. GAO-01-822. Washington, D.C.: September 20, 2001.
Combating Terrorism: Actions Needed to Improve DOD Antiterrorism
Program Implementation and Management. GAO-01-909. Washington,
D.C.: September 19, 2001.
Combating Terrorism: Comments on H.R. 525 to Create a President’s
Council on Domestic Terrorism Preparedness. GAO-01-555T. Washington,
D.C.: May 9, 2001.
Combating Terrorism: Accountability Over Medical Supplies Needs
Further Improvement. GAO-01-666T. Washington, D.C.: May 1, 2001.
Combating Terrorism: Observations on Options to Improve the Federal
Response. GAO-01-660T. Washington, DC: April 24, 2001.
Combating Terrorism: Accountability Over Medical Supplies Needs
Further Improvement. GAO-01-463. Washington, D.C.: March 30, 2001.
Combating Terrorism: Comments on Counterterrorism Leadership and
National Strategy. GAO-01-556T. Washington, D.C.: March 27, 2001.
Combating Terrorism: FEMA Continues to Make Progress in
Coordinating Preparedness and Response. GAO-01-15. Washington, D.C.:
March 20, 2001.
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Combating Terrorism: Federal Response Teams Provide Varied
Capabilities; Opportunities Remain to Improve Coordination. GAO-0114. Washington, D.C.: November 30, 2000.
Combating Terrorism: Need to Eliminate Duplicate Federal Weapons of
Mass Destruction Training. GAO/NSIAD-00-64. Washington, D.C.: March
21, 2000.
Combating Terrorism: Chemical and Biological Medical Supplies Are
Poorly Managed. GAO/T-HEHS/AIMD-00-59. Washington, D.C.: March 8,
2000.
Combating Terrorism: Chemical and Biological Medical Supplies Are
Poorly Managed. GAO/HEHS/AIMD-00-36. Washington, D.C.: October 29,
1999.
Combating Terrorism: Observations on the Threat of Chemical and
Biological Terrorism. GAO/T-NSIAD-00-50. Washington, D.C.: October 20,
1999.
Combating Terrorism: Need for Comprehensive Threat and Risk
Assessments of Chemical and Biological Attacks. GAO/NSIAD-99-163.
Washington, D.C.: September 14, 1999
Combating Terrorism: Use of National Guard Response Teams Is
Unclear. GAO/T-NSIAD-99-184. Washington, D.C.: June 23, 1999.
Combating Terrorism: Observations on Growth in Federal Programs.
GAO/T-NSIAD-99-181. Washington, D.C.: June 9, 1999.
Combating Terrorism: Analysis of Potential Emergency Response
Equipment and Sustainment Costs. GAO/NSIAD-99-151. Washington,
D.C.: June 9, 1999.
Combating Terrorism: Use of National Guard Response Teams Is
Unclear. GAO/NSIAD-99-110. Washington, D.C.: May 21, 1999.
Combating Terrorism: Observations on Federal Spending to Combat
Terrorism. GAO/T-NSIAD/GGD-99-107. Washington, D.C.: March 11, 1999.
Combating Terrorism: Opportunities to Improve Domestic Preparedness
Program Focus and Efficiency. GAO/NSIAD-99-3. Washington, D.C.:
November 12, 1998.
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Combating Terrorism: Observations on the Nunn-Lugar-Domenici
Domestic Preparedness Program. GAO/T-NSIAD-99-16. Washington, D.C.:
October 2, 1998.
Combating Terrorism: Observations on Crosscutting Issues. GAO/TNSIAD-98-164. Washington, D.C.: April 23, 1998.
Combating Terrorism: Threat and Risk Assessments Can Help Prioritize
and Target Program Investments. GAO/NSIAD-98-74. Washington, D.C.:
April 9, 1998.
Combating Terrorism: Spending on Governmentwide Programs
Requires Better Management and Coordination. GAO/NSIAD-98-39.
Washington, D.C.: December 1, 1997.
Disaster Assistance
Disaster Assistance: Improvement Needed in Disaster Declaration
Criteria and Eligibility Assurance Procedures. GAO-01-837. Washington,
D.C.: August 31, 2001.
Chemical Weapons: FEMA and Army Must Be Proactive in Preparing
States for Emergencies. GAO-01-850. Washington, D.C.: August 13, 2001.
Federal Emergency Management Agency: Status of Achieving Key
Outcomes and Addressing Major Management Challenges. GAO-01-832.
Washington, D.C.: July 9, 2001.
Budget and Management
Budget Issues: Long-Term Fiscal Challenges. GAO-02-467T. Washington,
D.C.: February 27, 2002.
Results-Oriented Budget Practices in Federal Agencies. GAO-01-1084SP.
Washington, D.C.: August 2001.
Managing for Results: Federal Managers’ Views on Key Management
Issues Vary Widely Across Agencies. GAO-01-592. Washington, D.C.: May
25, 2001.
Determining Performance and Accountability Challenges and High
Risks. GAO-01-159SP. Washington, D.C.: November 2000.
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Managing for Results: Using the Results Act to Address Mission
Fragmentation and Program Overlap. GAO-AIMD-97-146. Washington,
D.C.: August 29, 1997.
Government Restructuring: Identifying Potential Duplication in Federal
Missions and Approaches. GAO/T-AIMD-95-161. Washington, D.C.: June 7,
1995.
Government Reorganization: Issues and Principles. GAO/T-GGD/AIMD95-166. Washington, D.C.: May 17, 1995.
Grant Design
Grant Programs: Design Features Shape Flexibility, Accountability, and
Performance Information. GAO/GGD-98-137. Washington, D.C.: June 22,
1998.
Federal Grants: Design Improvements Could Help Federal Resources Go
Further. GAO/AIMD-97-7. Washington, D.C.: December 18, 1996.
Block Grants: Issues in Designing Accountability Provisions.
GAO/AIMD-95-226. Washington, D.C.: September 1, 1995.
(290212)
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